Ethical Considerations in Pediatric Deceased Solid Organ Donation

Pediatric deceased organ donation raises distinct ethical challenges involving death determination, parental authority, and emerging organ recovery and preservation technologies. Although many of these controversies extend beyond pediatrics, they are shaped by a context in which authorization rests with parents, donation is rare and technically complex, and families are navigating the loss of their child. This review synthesizes established and emerging controversies in deceased organ donation through a pediatric lens, examining definitions and determinations of death, conflicts between end-of-life care and organ preservation, societal and individual trust, the distinction between authorization and informed consent, normothermic regional perfusion, and the dead donor rule as the foundation of deceased donation. The controversies reflect a central tension: the desire to save lives through organ transplantation and the obligation to protect the dying child from harm. As transplantation medicine evolves, the ethical frameworks guiding donation must continue to adapt to protect donors, support families, and maintain public trust.